disinfection and sterilization in health care by Dr.T.V.Rao MD

STERILIZATION AND DISINFECTION
IN HEALTH CARE
Principles and Practice
Emphasis on Covid 19 Pandemic
Dr B Ranga Reddy MD
Dr.T.V.Rao MD
08-08-2021 Dr.T.V.Rao MD 2 Disinfection and Sterilization 1

A Tribute to
Ignaz Semmelweiss (1818-1865)
• Established that high
maternal mortality
was due to failure of
doctors to wash hands
after post mortems
•Hand washing
Reduced maternal
mortality by 90%

“What ~ William Osler said on
Disinfection

Why we need Sterilization
• Microorganisms capable of causing infection are constantly
present in the external environment and on the human
body.
• Human body contain 10 times more microbes than our
own Cells
• Microorganisms are responsible for contamination and
infection.
• The aim of sterilization and disinfection is to remove or
destroy them from materials or from surfaces.

The program file made with a new thinking
TRUST INDEX
• Trust Index is an initiative by
KSAT and Graham Media Group
to combat misinformation
campaigns and verify claims or
other online content that could
be false or misleading. The goal
is to reinforce journalism
ethics, give our readers and
viewers the facts and an
avenue to alert our newsroom
to potentially fake or harmful
information

Principles and practices of
Sterilization and Disinfection

What the sterilization Does
• refers to any process that effectively kills or eliminates transmissible agents
(microorganisms) such as,
• fungi,
• bacteria,
• viruses,
• Protozoa and helminths,
•prions and
• spore forms,
• from a surface, equipment, foods, medications, or
biological culture medium.

Contaminated Surfaces
VRE MRSA C.
difficile
Bed Rails +++++++ + +++
Bed Table ++++++ + -
Door Knobs ++ ++ +
Doors +++ + -
Call Button +++ + ++
Chair ++ + ++
Tray Table +++ ++ -
Toilet Surface + - ++++
Sink Surface + + +++
Bedpan Cleaner - - +
Carling PC, et al. Am J Infect Control. 2006 Oct;34(8):513-9.

Cleaning and Practising Hygiene is first
priority Before Sterilization
• All items must be cleaned using
water with detergents or
enzymatic cleaners before
processing.
Cleaning reduces the bio
burden and removes foreign
material (i.e., organic residue
and inorganic salts) that
interferes with the sterilization
process by acting as a barrier to
the sterilization agents

METHODS OF STERILIZATION
• The various methods of
sterilization are:
1. Physical Method
• (a) Thermal (Heat) methods
• (b) Radiation method
• (c) Filtration method
• 2. Chemical Method
• 3. Gaseous method

FACTORS INFLUENCING ABILITY TO
KILL MICROBES
• Strength of the killing agent
• Time that the agent has
to act
• Temperature of environment
rate of microbe death doubles
with every 10˚C rise in temp.
• Type of microbe
• Environment around the area to
be decontaminated
• Number of microbes to be killed

How can Microorganisms
be killed?
• Denaturation of proteins (e.g. wet heat, ethylene
oxide)
• Oxidation (e.g. dry heat, hydrogen peroxide)
• Filtration
• Interruption of DNA synthesis/repair (e.g. radiation)
• Interference with protein synthesis (e.g. bleach)
• Disruption of cell membranes (e.g. phenols)

TERMINOLOGY USED IN
STERILIZATION
• Sterilization – a process that destroys all viable microbes,
including viruses and endospores
• Disinfection – a process to destroy vegetative pathogens,
not endospores; inanimate objects
• Antiseptic – disinfectants applied directly to exposed
body surfaces
• Sanitization – any cleansing technique that mechanically
removes microbes

Disinfection x Sterilization
• Sterilization is absolute, removes
microbes and spores too.
• To achieve Sterilization is Expensive,
not sustainable, many times not
needed.
• However An effective Disinfection
reduces the infections drastically. Hand
Washing

Physical Methods of Microbial
Control
• Heat
• Kills microorganisms by denaturing their enzymes and other
proteins. Heat resistance varies widely among microbes.
• fast, reliable, inexpensive
• does not introduce potential toxic substances
•types of heat control include
• moist heat
• pasteurization
• dry heat

Antimicrobial Definitions
•Disinfection
• May use physical or chemical methods
• Disinfectant: An agent applied to inanimate objects.
• Antiseptic: A substance applied to living tissue.
• Degerming: Removal of most microbes in a limited area.
Example: Alcohol swab on skin.
• Sanitization: Use of chemical agent on food-handling
equipment to meet public health standards and minimize
chances of disease transmission. e.g.: Hot soap & water

Control
• Moist Heat: Kills microorganisms
by coagulating their proteins.
• Boiling: Heat to 100oC or more at
sea level. Kills vegetative forms of
bacterial pathogens. Most
pathogens can be killed within 10
minutes or less. Endospores and
some viruses are not destroyed
this quickly.
• In general, moist heat is much
more effective than dry heat.

Control
• Pasteurization: Developed by Louis
Pasteur to prevent the spoilage of
beverages. Used to reduce microbes
responsible for spoilage of beer, milk,
wine, juices, etc.
• Classic Method of Pasteurization:
Milk was exposed to 65oC for 30
minutes.
• High Temperature Short Time
Pasteurization (HTST): Used today.
Milk is exposed to 72oC for 15
seconds.

Control
• Moist Heat (Continued):
• Reliable sterilization with moist heat
requires temperatures above that of
boiling water.
• Autoclave: Chamber which is filled
with hot steam under pressure.
Preferred method of sterilization,
unless material is damaged by heat,
moisture, or high pressure.
• Temperature of steam reaches 121oC
at twice atmospheric pressure.
• All organisms and endospores are
killed within 15 minutes.

Figure 9.1 A plot of microbial death rate
90% die
1 min
90% die
1 min
Constant percentage
of the extant population
is killed each minute
Time (min)
Number
of
living
microbes

Spaulding Classification
Category Description Requirement
Critical Enters sterile body cavity Sterile
Semi-critical Contacts mucous
membranes, non-intact
skin
High level
disinfection
Non-critical Contacts intact skin Low level
disinfection

Factors that influence efficacy
of disinfection/sterilization
 Contact time
 Physico-chemical environment (e.g. pH)
3 Presence of organic material
4 Temperature
5 Type of microorganism
6 Number of microorganisms
7 Material composition
CREATE SOPS AND DOCUMENT

• Uses of sterilization:
1.Sterilization of materials, instruments
used in surgical and diagnostic
procedures.
2.Sterilisation of Media and reagents
used in the microbiology laboratory.
3.Food and drug manufacturing to
ensure safety from contaminating
organisms.

“IDEAL” STERILIZATION
METHOD
• Highly efficacious
• Rapidly active
• Strong penetrability
• Materials compatibility
• Non-toxic
• Organic material resistance
• Adaptability
• Monitoring capability
• Cost-effective
• Schneider PM. Tappi J. 1994;77:115-11

Most Resistant
• Endospores
• Mycobacteria
• Fungal Spores
• Small Non-enveloped viruses (polio, rotavirus,
rabies)
• Vegetative Fungal Cells
• Enveloped Viruses (Herpes, Hepatitis B, Hepatitis C,
HIV)

SPORICIDAL AGENTS
•Glutaraldehyde
•Formaldehyde
• Other aldehydes
•Chlorine-releasing agents
• Iodine and iodophores
• Peroxygens
• Ethylene oxide
• P-Propiolactone

HOW STERILIZATION WORKS
• Cell wall maintains integrity of cell
• When disrupted, cannot prevent cell from bursting due to
osmotic effects• Cytoplasmic membrane contains
cytoplasm and controls passage of chemicals into and out
of cell• When damaged, cellular contents leak out
• Viral envelope responsible for attachment of virus to target
cell
• Damage to envelope interrupts viral replication
• So…non enveloped viruses have greater tolerance of harsh
conditions

Disinfection
• Process of reducing or
eliminating living
pathogenic
microorganisms in or on
materials, so they are no
longer a health hazard.
•For example: use of
alcohol before drug
injection.

Sterilization and Disinfection
Rapidly changing Science

What to sterilize?
•It is mandatory to sterilize :
•all instruments that penetrate soft tissues and
bone.
• Instruments that are not intended to penetrate
the tissues, but that may come into contact with
oral tissues.
•If the sterilization procedure may damage the
instruments, then, sterilization can be
replaced by Disinfection procedure

Basic principles on cleaning
• Start cleaning from cleaner
areas and proceed towards
dirtier areas.
All indoor areas such as entrance
lobbies, corridors and staircases,
escalators, elevators, security
guard booths, office rooms,
meeting rooms, cafeteria should
be mopped with a disinfectant
with 1% sodium hypochlorite or
phenolic disinfectants.

INITIAL CLEANING
• After having completed all
the various phases of laying
there is one final operation:
cleaning. Appropriate
cleaning that highlights the
aesthetic qualities of the
material laid and at the
same time restores the level
of cleanability

ORDINARY CLEANING
• Clean the floor with clean
lukewarm water, adding
detergents such as Emulsio
Lysoform Casa, Aiax or Fila Cleaner
diluted according to their
instructions On a textured surface
the use of a rough cloth is
recommended. No special
treatments are necessary.
• DETERGENTS
• Any of the detergents currently on
the market may be used, following
diluting instructions,

WHAT ARE LYSOL PRODUCTS
• The active ingredient in many
Lysol products is benzalkonium
chloride, but the active
ingredient in the Lysol "Power
and Free" line is hydrogen
peroxide. Lysol has been used
since its invention in the late
19th century as a household
and industrial cleaning agent,
and previously as a medical
disinfectant.

The guidelines for
preparing fresh 1% sodium hypochlorite
solution i
• Sodium hypochlorite – liquid
bleach 3.5% 1 part bleach to 2.5
parts water
• Sodium hypochlorite – liquid 5%
1 part bleach to 4 parts water
• Bleaching powder 70% 7g g to 1
litre water
• Chloramine – powder 25% 80 g
to 1 litre water

General Methods in Cleaning
• High contact surfaces such elevator buttons, handrails / handles and
call buttons, escalator handrails, public counters, intercom systems,
equipment like telephone,
• printers/scanners, and other office machines should be cleaned
twice daily by mopping
• with a linen/absorbable cloth soaked in 1% sodium hypochlorite.
Frequently touched areaslike table tops, chair handles, pens, diary
files, keyboards, mouse, mouse pad, tea/coffee dispensing
machines etc. should specially be cleaned.

Soap and detergents
•Soaps are sodium
or potassium salts
of fatty acids, a
natural product
•Detergents, instead,
are artificial
surfactants

What Soap I use in Routine life and Health care
Non Medicated or Medicated

What soap is better for Covid 19
Routine soaps we use are still the best
• What about antibacterial soaps? What’s so special about them, and
are they better or worse?
• As it turns out, there’s no benefit to using antibacterial soap (in this
case, against COVID-19). Antibacterial soaps contain an additive,
usually a compound called triclosan, that jams up some of the
machinery inside bacteria.
The FDA, however, has found in multiple studies that
antibacterial soap is no more effective than normal
soap.

Shall we use Solid Soap or Liquid
Soap

What we should choose
•Don’t discriminate
when choosing soap
— as long as it’s
lathering up, leaving
bubbles, and acting as
a molecular
surfactant, it’s killing
bacteria or
coronavirus!

What are Detergents in
Laundry
• A detergent is a of
surfactant or surfactants
ora mixture with cleansing
properties in dilute
solutions. These substances
are usually alkylbenzene
sulfonates, a family of
compounds that are similar
to soap but are more
soluble in hard water,

Halogens
• Halogens are the seventh (VII) column of the periodic table of elements
• Two halogens are regularly employed as antimicrobials: Iodine and
Chloride
• Iodine: commonly used as an antiseptic against all microbes, fungi, and
viruses
• Iodine: It inhibits protein synthesis and oxidizes –SH groups of amino acids
• Chlorine: Used as a disinfectant (10% bleach)
• Chlorine: Hypochlorous acid (HOCl) is a product, formed in water, that is the
active form of the disinfectant
• Chlorine: Applied in treatment of drinking water, swimming pool,
• and sewage

Hypochlorite's
•They have a broad
spectrum of
antimicrobial activity,
are unaffected by
water hardness, are
inexpensive and fast
acting, and have a low
incidence of serious
toxicity

Hypochlorite's
•Hypochlorite's can eliminate both enveloped and
non enveloped viruses if used in correct dilution
and contact time. They are also is effective
against fungi, bacteria, and algae but not spores.
Household bleach is typically diluted using
1:50 with water (1000ppm) for surface
disinfection. Bleach solutions have been
recommended for use in both hospitals and the
community as disinfecting solutions

Disadvantages of Hypochlorite's
• Disadvantages of
hypochlorite's include
corrosiveness to metals in
high concentrations (>500
ppm), inactivation by
organic matter, discoloring
or “bleaching” of fabrics,
and release of toxic chlorine
gas when mixed with
ammonia or acid.

Hypochlorite's
•Chlorinated drinking
water should not exceed
1 to 2 ??? ppm of free
chlorine with the lower
value being in
continuous flow or low
volume reservoir
systems.

Spraying alcohol, chlorine all over your body
won’t prevent COVID-19 infection –WHO
• Spraying alcohol or chlorine
all over your body will not
kill viruses that have
already entered your body.
Spraying such substances
can be harmful to clothes or
mucous membranes (i.e.
eyes, mouth).

Hydrogen Peroxide
Peroxides such as hydrogen peroxide are often used as
antiseptics to clean wounds. The activity of peroxides
is greatest against anaerobic bacteria. Hydrogen
peroxide at high concentrations is in some cases is
damaging to tissues, resulting in a prolonged healing
time. It is useful for cleaning surgical sites after
closure, but use sparingly to avoid penetrating suture
lines, which would inhibit healing

Phenol as Disinfectant
Phenolic disinfectants are effective
against bacteria (especially gram
positive bacteria) and enveloped
viruses.
They are not effective against non
enveloped viruses and spores.
These disinfectants maintain their
activity in the presence of organic
material.

PHENOLICS
•Phenol is probably the oldest known disinfectant as it was first
used by Lister, when it was called carbolic acid.
• Phenolics are active ingredients in some household disinfectants.
They are also found in some mouthwashes and in disinfectant soap
and handwashes.
• Phenolics are tuberculocidal
• It is rather corrosive to the skin and sometimes toxic to sensitive
people.
• O-phenylphenol is often used instead of Phenol, since it is somewhat
less corrosive.

What are Phenols and Phenolics
• Phenols and Phenolics:
• Phenol (carbolic acid) was first used by Lister as a disinfectant.
• Rarely used today because it is a skin irritant and has strong odor.
• Phenolics are chemical derivatives of phenol
• Cresols (Lysol): Derived from coal tar.
• Biphenols: Effective against gram-positive staphylococci and
streptococci. Excessive use in infants may cause
neurological damage

Phenol as Disinfectant Not
effective
• Phenolics are not
recommended for semi
critical items because of the
lack of validated efficacy
data for many of the
available formulations and
because the residual
disinfectant on
porousmaterials may cause
tissue irritation even when
thoroughly rinsed

Chloroxylenol
• Chloroxylenol is the principal
ingredient in Dettol, a
household disinfectant and
antiseptic.
• Thymol, derived from the herb
thyme, is the active ingredient
in the only 100% botanical
disinfectant "broad spectrum,"
or hospital-grade, it is also the
only disinfectant with a green
certification, Environmental
Choice.

Iodine And Iodophor
Disinfectants
• These compounds have been
incorporated in time release
formulations and in soaps
(surgical scrubs).
• Simple iodine tinctures (dissolved
in alcohol) have limited cleaning
ability. These compounds are
bactericidal, parricidal, virucidal
and fungicidal but require a
prolonged contact time.

Chlorhexidine Gluconate
• Chlorhexidine Gluconate is the
gluconate salt form of
chlorhexidine, a biguanide
compound used as an antiseptic
agent with topical antibacterial
activity. Chlorhexidine
gluconate is positively charged
and reacts with the negatively
charged microbial cell surface,
thereby destroying the integrity
of the cell membrane..

Chlorhexidine Gluconate
• Subsequently, chlorhexidine
gluconate penetrates into the
cell and causes leakage of
intracellular components leading
to cell death. Since gram positive
bacteria are more negatively
charged, they are more sensitive
to this agent

Hydrogen Peroxide
Peroxides such as hydrogen peroxide are often
used as antiseptics to clean wounds. The activity of
peroxides is greatest against anaerobic bacteria.
Hydrogen peroxide at high concentrations is in some
cases is damaging to tissues, resulting in a
prolonged healing time. It is useful for cleaning
surgical sites after closure, but use sparingly to avoid
penetrating suture lines, which would inhibit healing

Hydrogen Peroxide
• Stabilized hydrogen
peroxides can be used to
disinfect environmental
surfaces.
• The literature contains
several accounts of the
properties, germicidal
effectiveness, and potential
uses for stabilized hydrogen
peroxide in the hospital
settings

Aldehydes:
• Aldehydes:
• Include some of the most effective antimicrobials.
• Inactivate proteins by forming covalent crosslinks with several functional
groups.
• Formaldehyde:
• Excellent disinfectant, 2% aqueous solution.
• Commonly used as formalin, a 37% aqueous solution.
• Formalin was used extensively to preserve biological specimens and
inactivate viruses and bacteria in vaccines.
• Irritates mucous membranes, strong odor.

ALDEHYDES
• Aldehydes, such as Glutaraldehyde, have a wide
microbiocidal activity and are sporocidal and
fungicidal.
• They are partly inactivated by organic matter and
have slight residual activity.
• Glutaraldehyde and formaldehyde are volatile, and
toxic by both skin contact and inhalation.
• Glutaraldehyde has a short shelf life (<2 weeks), and
is expensive.

ALDEHYDES
• Denature proteins and
inactivate nucleic acids
• Glutaraldehyde both
disinfects (short exposure)
and sterilizes (long
exposure)
• Formalin used in
embalming and disinfection
of rooms and instruments

Formaldehyde
• Formaldehyde is less expensive and has a much
longer shelf life if some methanol is added to inhibit
polymerization to paraformaldehyde, but is much
more volatile
• Formaldehyde is also used as a gaseous sterilizing
agent; in this case, it is prepared on-site by
depolymerization of solid paraformaldehyde

Iodine And Iodophor
Disinfectants
• These compounds have been
incorporated in time release
formulations and in soaps
(surgical scrubs).
• Simple iodine tinctures (dissolved
in alcohol) have limited cleaning
ability. These compounds are
bactericidal, parricidal, virucidal
and fungicidal but require a
prolonged contact time.

BETADINE
Betadine destroys organisms like
viruses, fungus, bacteria, protozoa, and
spores on the skin. When applied to
the infected area, this medicine arrests
escalating infection.
Povidone iodine, the key ingredient
in Betadine is extremely popular as a
preoperative antiseptic to sanitize the
skin prior to a surgical procedure. This
medicine is a good first aid measure.
This agent is also under the lens for its
role in treating ocular diseases such as
viral conjunctivitis.

Alcohols
• “Alcohol" refers to two water-soluble
chemicals: ethyl alcohol and
isopropyl alcohol. These alcohols
are rapidly bactericidal rather than
bacteriostatic against vegetative forms
of bacteria (Gram + and Gram -); they
also are tuberculocidal, fungicidal, and
virucidal against enveloped viruses.
Alcohols are not effective against
bacterial spores and have limited
effectiveness against nonenveloped
viruses

ISOPROPYL ALCOHOL (70%)
• Powerful disinfectant and
antiseptic
• Mode of action: denatures
proteins, dissolves lipids and
can lead to cell membrane
disintegration
• Effectively kills bacteria and
fungi
• But does not inactivate spores!

Gaining importance in Hand Washing with
Alcohols
• The use of either ethyl alcohol
or isopropyl alcohol in a 60-
90% solution has recently
gained wide acceptance in
health care settings as hand
antiseptics. They can be used
as a reasonable substitute for
handwashing as long as hands
are not visibly soiled

GASEOUS AGENTS
• Ethylene oxide, propylene
oxide, and betapropiolactone
used in closed chambers to
sterilize items
• Denature proteins and DNA by
cross-linking functional groups
• Used in hospitals and dental
offices
• Can be hazardous to people,
often highly explosive,
extremely poisonous, and are
potentially carcinogenic

The Following have saved many
lives in Covid 19 Pandemic

Structure of Corona Virus

Spread of Covid 19 ???
• The principal mode by which
people are infected with SARS-
CoV-2 ( COVID-19) is through
exposure to respiratory
droplets carrying infectious
virus. It is possible for people
to be infected through contact
with contaminated surfaces or
objects (fomites), but the risk
is generally considered to
be low.

Surface Transmission of SARS-
CoV-2
•However, it is not clear
what proportion of
SARS-CoV-2 infections
are acquired through
surface transmission.
There have been few
reports of COVID-19
cases potentially
attributed to fomite
transmission

Fomites can Transmit ???
• Infections can often be
attributed to multiple
transmission pathways.
Fomite transmission is
difficult to prove
definitively, in part because
respiratory transmission
from asymptomatic people
cannot be ruled out

Good suggestion to prevent spread
Covid 19 on Scientific basis

Covid 19 infections and
Role of Disinfection
•Outbreak of coronavirus (COVID-19) has led to
a broad use of chemical disinfectants in order
to sterilize public spaces and prevent
contamination
• A recent study has shown that COVID-19 virus
can survive on infected surfaces up to 9 days
and it remains infective ,which increases its
spread among the public

Chemicals Impacts In Fighting
The Spread Of COVID-19
• The coronavirus pandemic
has lead to major changes
for homes and businesses,
including more frequent use
of chemicals and
disinfectants. While they
do help, some can be
dangerous to human health
and the environment.

Best suggestion From WHO
• Thus, in order to minimize the
chances of infection, public health
agencies ( WHO) has encouraged
and recommended that
individuals maintain high levels of
personal hygiene by frequently
washing their hands with soap for
a minimum of 20 s or by using
disinfectants that can deactivate
and kill the virus and eliminate its
infectivity.

Spraying alcohol, chlorine all over your body
won’t prevent COVID-19 infection –WHO
• No. Spraying alcohol or
chlorine all over your body
will not kill viruses that
have already entered your
body. Spraying such
substances can be harmful
to clothes or mucous
membranes (i.e. eyes,
mouth).

CHEMICAL DISINFECTANTS AND THEIR
EFFECTS
ON THE VIRUS
• Ethanol and isopropanol are the main alcohols used as
disinfectants for a broad spectrum of bacteria, viruses,
andfungi. The biocidal activity of these alcohols is
dependenton their concentration and hydro affinity. The
optimal concentration for antimicrobial activity is at 60–
80% ofalcohol where ethanol is superior to isopropanol
againsthydrophilic viruses, such as rotavirus, human
immunodeficiency virus (HIV), and coronaviruses, while
isopropanol is more active against lipophilic viruses, such
poliovirusand hepatitis

Principle of destroying Corona Virus

How we deliver the sterile
products means a lot ?????
• The delivery of sterile products for use in patient
care depends not only on the effectiveness of the
sterilization process but also on the unit design,
decontamination, disassembling and packaging of
the device, loading the sterilizer, monitoring,
sterilant quality and quantity, and the
appropriateness of the cycle for the load contents,
and other aspects of device reprocessing.

What is wrong with our
Practices
• Disinfectants used indiscrimately,
• Used unnecessarily
• Not used when needed.
• Concentration not adequate
• Economic consideration,
• Business promotions.
• Laboratory testing X Hospital
conditions may not correlate.
Dr.T.V.Rao MD 2 Disinfection and Sterilization 86
08-08-2021

Environmental measures
• Cleaning and disinfecting
non-critical surfaces in
patient-care areas are part
of Standard Precautions. In
general, these procedures
do not need to be changed
for patients on
Transmission-Based
Precautions.
08-08-2021

Environmental measures
• The cleaning and disinfection of
all patient-care areas is
important for frequently
touched surfaces, especially
those closest to the patient,
that are most likely to be
contaminated (e.g., bedrails,
bedside tables, commodes,
doorknobs, sinks, surfaces and
equipment in close proximity to
the patient)

What disinfects used for
cleaning
•The disinfectants or detergents/disinfectants that
best meet the overall needs of the healthcare
facility for routine cleaning and disinfection
should be selected . In general, use of the existing
facility detergent/disinfectant according to the
manufacturer’s recommendations for amount,
dilution, and contact time is sufficient to remove
pathogens from surfaces of rooms where
colonized or infected individuals were housed.
08-08-2021

Virkon Continues to be a Safe compound in
Health care
• US EPA Registered – Virkon™ S
has a significant number of
studies supporting approved US
EPA master label claims against
disease-causing organisms
• Virkon has a strong detergent
and disinfectant action. Inhibits
all known viruses, fungi,
bacteria, mold, yeast (the same
applies to the hepatitis B virus
and AIDS with adequate
exposure). During cleaning
prevents the dispersion of
micro-organisms, non-staining,
non-corrosive, non-polluting.

Virkon is used according to instructions:
:
• When spring cleaning in medical and care institutions;
• For cleaning and disinfection of medical equipment (bronchoscopy,
laparoscopy, endoscopy, medical instruments, etc.);
• To disinfect all surfaces in the premises of public facilities (hotels, hostels,
etc..), In sanitary rooms, indoor public catering;
• For disinfection and decontamination located on fabrics and surfaces of
blood, in order to avoid contamination in blood transfusion;
• To disinfect aquariums;
• To disinfect the premises, where previously there were animals.

WHAT NEXT ????
• Many New technologies
• Gas plasma
• Green Chemical concept

References
• CDC Atlanta current issues on Covid 19
• NIH
• WHO
• Guideline for Disinfection and Sterilization in HealthcareFacilities,
2008Update: May 2019

disinfection and sterilization in health care by Dr.T.V.Rao MD

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